Gupta Monica, Filler Guido, Kovesi Thomas, Shaw Laura, Forget Christine, Carpenter Blair, Reisman Joe, Feber Janusz, Diaz-Mitoma Francisco
Department of Pediatrics, Division of Pediatric Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Am J Kidney Dis. 2003 Jan;41(1):212-9. doi: 10.1053/ajkd.2003.50006.
Infections caused by herpes virus, in particular, Epstein-Barr virus (EBV), remain a major challenge in solid organ transplantation. Little is known about the significance of tissue EBV load.
Twenty-three tissue biopsy specimens (19 kidney, 3 gastrointestinal, and 1 tonsil specimen) and 2 bronchoalveolar lavage specimens from 14 pediatric transplant recipients (10 kidney, 3 liver, 1 combined transplant) were subject to tissue EBV polymerase chain reaction (PCR) semiquantitative analysis and enzyme-linked immunosorbent assay (ELISA) methods. Results of biopsies were correlated with clinical data.
Five of 14 patients had clinically diagnosed EBV disease: 2 patients presented with a septic picture with multiorgan failure and pneumonitis; 1 patient had mononucleosis; 1 patient had an increase in serum creatinine level, lymphadenopathy, and chronic fatigue; and 1 patient had EBV nephritis. These 5 patients underwent 12 biopsies at the time of clinically active infection; 8 biopsies had positive results (up to 111 copies/10 microL of extracted DNA). Conversely, 1 of the remaining 13 tissue biopsy specimens from asymptomatic patients had positive results on ELISA, but undetectable viral load, whereas 8 patients had a positive EBV immunoglobulin G titer with historic evidence of EBV replication in the blood. No patient without evidence of EBV had positive EBV tissue PCR results.
Increased EBV load was found in more than 50% of patients, pointing to a previously underrecognized importance of EBV detection in tissues from transplant recipients. The presence of EBV in tissue correlated with the presence of viremia, whereas tissue PCR had 100% specificity. EBV load should be included in biopsy evaluation.
疱疹病毒引起的感染，尤其是爱泼斯坦-巴尔病毒（EBV），仍然是实体器官移植中的一个重大挑战。关于组织EBV载量的意义知之甚少。
对14名儿科移植受者（10例肾移植、3例肝移植、1例联合移植）的23份组织活检标本（19份肾组织、3份胃肠道组织和1份扁桃体组织）以及2份支气管肺泡灌洗标本进行组织EBV聚合酶链反应（PCR）半定量分析和酶联免疫吸附测定（ELISA）。活检结果与临床数据相关联。
14名患者中有5名临床诊断为EBV疾病：2名患者表现为败血症伴多器官功能衰竭和肺炎；1名患者患有单核细胞增多症；1名患者血清肌酐水平升高、淋巴结病和慢性疲劳；1名患者患有EBV肾炎。这5名患者在临床活跃感染时进行了12次活检；8次活检结果为阳性（提取的DNA高达111拷贝/10微升）。相反，无症状患者的其余13份组织活检标本中有1份ELISA结果为阳性，但病毒载量检测不到，而8名患者EBV免疫球蛋白G滴度为阳性，有血液中EBV复制的历史证据。没有EBV证据的患者EBV组织PCR结果均为阴性。
超过50%的患者EBV载量增加，这表明移植受者组织中EBV检测的重要性此前未得到充分认识。组织中EBV的存在与病毒血症的存在相关，而组织PCR具有100%的特异性。活检评估应包括EBV载量。
